PrEP Regimen Management in Bariatric Surgery Patients

Introduction to PrEP Management

The American College of Physicians and other medical guidelines recommend continuing the current daily emtricitabine/tenofovir disoproxil fumarate regimen without any dose adjustments before or after bariatric surgery, as there is no evidence that bariatric surgery affects PrEP efficacy 1, 2.

Daily tenofovir disoproxil fumarate/emtricitabine is the recommended oral PrEP regimen for all populations at risk, with proven efficacy when taken as prescribed, according to the Centers for Disease Control and Prevention 1, 2.
The standard dose is one tablet daily (tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg), and this should not be altered based on surgical procedures, as stated by the World Health Organization 1, 3.

Reducing the frequency of PrEP dosing to every other day is contraindicated because daily dosing is required for optimal protection, particularly for individuals with vaginal tissue, where tenofovir concentrates at 10-fold lower levels than in rectal tissue, according to the National Institutes of Health 4, 5.
Event-driven dosing is inappropriate for transgender men, as it is only recommended for cisgender men who have sex with men (MSM), and efficacy data exist only for MSM with receptive anal intercourse, as stated by the European Centre for Disease Prevention and Control 1, 2, 4, 5.

Ensure the patient maintains daily adherence to the current PrEP regimen through the perioperative period, and coordinate with the surgical team to continue oral medications on the day of surgery if possible, or resume as soon as oral intake is tolerated postoperatively, according to the American College of Surgeons 1, 3.
Continue standard PrEP monitoring, including HIV testing quarterly, creatinine clearance at first quarterly visit and annually thereafter, and STI screening quarterly, as recommended by the Centers for Disease Control and Prevention 1, 6, 3.

The patient's gender identity as a transgender male means he may have vaginal tissue requiring the full 7-day protective window after PrEP initiation or interruption, not the 2-day window applicable to rectal tissue in MSM, according to the World Health Organization 1, 2.